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Query: UMLS:C0344329 (collapse)
 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The noninvasive diagnosis of impaired mechanical integrity or compliance of the trachea is most accurately made by fluoroscopic observation recorded on video tape or cineradiography, with or without benefit of artificial contrast media (contrast tracheography). In particular, localized buckling, collapse or dilatation indicative of focal tracheomalacia may thus be diagnosed in vivo and correlated with diseases of the central airways. Congenital tracheomalacia is a rare, bu, well described entity. Cases of acquired tracheomalacia occur with increasing frequency, but are often not clearly recognized. We contrast the dynamic behavior of the normal trachea with the abnormal dynamics characteristic of focal tracheomalacia. Such lesions may result from trauma, surgical procedures, chronic irritation, inflammation, mechanical changes, or malignancy.
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PMID:Acquired tracheomalacia: etiology and differential diagnosis. 16 5

This study reviews our experience from 1977 to 1991 with 32 children born with esophageal atresia and tracheoesophageal fistula (EA-TEF) who later underwent surgery for severe tracheomalacia. Indications for surgery included dying spells (21), inability to extubate the airway (nasotracheal tube 5, tracheotomy 3), and recurrent pneumonia (3). Diagnosis was confirmed by chest x-ray, esophagogram, and bronchoscopy. Aortopexy was performed in 31 of 32 children; a splint without aortopexy was used in one older girl. Splinting was also necessary in two of the 31 at the initial operation, when aortopexy failed to prevent tracheal collapse. There were four initial failures. Currently, 29 children are well (median follow-up, 6.6 years). Two have a tracheostomy in place, and one, who had a vascular ring divided after aortopexy, died at home of unknown cause 1 month later. These findings indicate that aortopexy provides long-term relief of severe symptoms of tracheomalacia associated with EA-TEF in almost all affected children. When aortopexy fails, the insertion of an airway splint may succeed; otherwise, tracheostomy is necessary.
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PMID:Severe tracheomalacia associated with esophageal atresia: results of surgical treatment. 140 50

Fifty-eight infants and children with various tracheobronchial obstructions were surgically treated at Kobe Children's Hospital between 1980 and 1991. The lesions included subglottic stenosis (24), congenital tracheal stenosis (9), tracheomalacia (15), bronchomalacia (6), and others (4). The operative procedures included laryngotracheoplasty using costal cartilage or anterior cricoid split for subglottic stenosis, tracheoplasty with costal cartilage graft for extensive tracheal stenosis, aortopexy for tracheomalacia, and external stenting or bronchial resection with tracheo-bronchial anastomosis for bronchomalacia. In 46 of 58 patients, the endotracheal tube was successfully removed and the patient remained free of respiratory symptoms. These operative results encourage us to continue all surgical procedures except for external stenting for bronchomalacia, which did not correct the collapse of the bronchus.
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PMID:[Tracheobronchial reconstruction in infants and children]. 150 74

We report our recent findings on the diagnosis, incidence, appearance of the trachea at autopsy, and surgical treatment of acquired trachobronchomalacia. In the diagnosis of this disease, continuous dynamic CT scanning (1 slice/0.6 second) from inspiration to deep expiration was better than X-ray cine recording. It is difficult to observe the most collapsed airway on coughing using bronchofiberscopic recording, because its duration time was estimated to be 1/10 second by X-ray cine recording, whereas the findings at one instant were easily recorded by video-bronchoscopy on coughing. The degree of severity of this disease was classified into three groups. 1st degree 0-50% narrowing of airway caliber, 2nd degree 50-75%; and 3rd degree 75-100%. Severity of 2nd or 3rd degree was present in 542 (12.7%) of 4283 patients suffering from chest disease who underwent bronchoscopy. Seventy-two percent of patients were aged 50 to 80 years. Third degree tracheomalacia was found in 131 patients with an incidence of 3.1%, which increased from 2.2% at 50 years to 6.2% at 80 years. The autopsy findings of the trachea consisted of fragmentation of the tracheal cartilage and extension of the membranous portion. The pathogenesis may be varied with different types of collapse of the airway, including the saber sheath type and the crescent type. Surgical treatment consists of prevention of the airway collapse by wrapping the airway with Marlex mesh and bonding Lyodura (lyophilized dura mata) with fibrin glue, which is more reliable than the span plasty proposed by Nissen.
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PMID:[Diagnosis, incidence, clinicopathology and surgical treatment of acquired tracheobronchomalacia]. 150 76

Magnetic resonance imaging of the trachea was performed in 21 children with congenital or acquired narrowing of the trachea or main bronchi. Diagnosis included aortic arch anomalies, innominate artery compression, pulmonary artery compression and tracheomalacia. All patients were examined after bronchoscopy. The demonstration of the trachea and the surrounding tissue and vessels on MR images enables the cause of tracheal compression and the degree and location of collapse to be evaluated. MRI is a modality well suited to characterizing tracheal narrowing without employing ionizing radiation or intravenous contrast medium. All MRI examinations were carried out with the patient under general anaesthesia so as not to risk pulmonary deterioration during sedation. In the cases presented MRI is the diagnostic step of choice after tracheobronchoscopy and broadens the diagnostic potential in extrinsic tracheal or bronchial stenosis in paediatric patients.
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PMID:Magnetic resonance imaging as a new diagnostic criterion in paediatric airway obstruction. 190 84

Artificial tracheas were fabricated from poly(L-lactic acid) mesh or unwoven cloth coated with collagen in order to reconstruct the respiratory airway by self regeneration without retaining the prosthesis at the replacement site, thus preventing infection, air leakage, granulation tissue formation, and displacement of the prosthesis. Nine weeks after placing a periosteal autologous graft from the tibia around the cervical trachea of a rabbit, bone rings formed without infection. Two weeks after replacement of an 8 X 8 mm window-shaped section of the cervical trachea with autologous periosteum, the internal surface of the trachea was well epithelialized without local complications, but ossification was not seen. One week after cervical substitution with our 2 cm long artificial trachea combined with the periosteal graft, cartilage was produced around the mesh material but neither ossification nor epithelization was observed thereafter, probably due to local infection. On the other hand, cartilage, bone, and epithelium did not form around the unwoven cloth artificial trachea after the substitution, probably because of severe infection due to collapse of the tracheal lumen. However, the formation of bone rings around the trachea suggests preservation of the neotracheal lumen, which may have potential for the treatment of tracheomalacia and/or bronchomalacia.
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PMID:Experimental studies on an artificial trachea of collagen-coated poly(L-lactic acid) mesh or unwoven cloth combined with a periosteal graft. 201 15

We evaluated the role of ultrafast CT in the diagnosis and follow-up of nine consecutive, symptomatic infants with suspected laryngeal and tracheobronchial obstruction after surgery for esophageal atresia. With 80% or more area collapse as a criterion for the diagnosis of laryngomalacia and 50% or more for tracheomalacia, six patients had tracheomalacia, one had laryngomalacia, and two had both. Tracheomalacia was focal in four patients and diffuse, involving the thoracic trachea, in the other four. Associated bronchomalacia was present in two patients. The site and degree of abnormality were verified by endoscopy in five of nine patients. The degree of tracheal collapse did not always correlate with the size of the esophageal pouch or with the site of the tracheo-esophageal fistula. These findings support the concept that the larynx and/or tracheal walls are often abnormal in symptomatic infants with esophageal atresia, tracheoesophageal fistula, and airway obstruction. Ultrafast CT was a reliable technique for detecting and assessing the site, extent, severity, and dynamics of airway collapse in five of seven symptomatic infants with congenital tracheoesophageal anomalies when the imaging findings were compared with endoscopic findings and previously published normal standards.
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PMID:Ultrafast CT of laryngeal and tracheobronchial obstruction in symptomatic postoperative infants with esophageal atresia and tracheoesophageal fistula. 210 29

Magnetic resonance (MR) imaging of the trachea was performed in 27 children with congenital tracheal narrowing. The diagnoses included aortic arch anomalies (n = 7), innominate artery compression (n = 13), pulmonary artery compression (n = 5), and tracheomalacia (n = 2). Demonstration of the trachea and the surrounding tissue and vessels on MR images allowed the evaluation of the cause of tracheal compression and the degree and location of collapse. Patients were examined with MR imaging if the cause of airway obstruction was still unclear after bronchoscopy. It is concluded that MR imaging is a well suited modality for characterizing tracheal narrowing without using ionizing radiation or intravenous contrast medium.
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PMID:MR imaging in pediatric airway obstruction. 231 44

A 60-pack-year smoker presented with cough, dyspnea and orthopnea of three months' duration. Spirometry revealed severe reduction in maximal expiratory flow; CT of the chest and bronchoscopy demonstrated expiratory collapse of a mid-tracheal segment, and a presumptive diagnosis of tracheomalacia was made. A right lateral thoracotomy was performed to resect the unstable segment and improve maximal expiratory flow. Diffuse major airway disease with absence of cartilaginous rings from the thoracic inlet to the mainstem bronchi was encountered. The trachea and mainstem bronchi were stented externally. A high resistance to airflow and absence of expiratory flow limitation were present, suggesting a fixed rather than variable intrathoracic obstruction of major airways. This case illustrates some potential pitfalls in preoperative assessment of patients with tracheomalacia. Recordings of airway pressure and flow during mechanical ventilation are useful in distinguishing between fixed and variable intrathoracic obstruction and may complement tests of airway anatomy.
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PMID:The assessment of major airway function in a ventilator-dependent patient with tracheomalacia. 232 60

Extensive tracheal stenotic lesions caused by tracheomalacia or neoplasms represent a surgical challenge. Segmental tracheal substitution is sometimes required to obtain radical cure. We present an experimental study of 27 dogs undergoing replacement of the cervical trachea using a vascularized small bowel segment as a tubular graft. A silicone stent was placed in the lumen of the intestinal fragment and was removed the second week after operation. Endoscopic and histological examinations were performed between the first week and second month after operation, and rigidity of the graft was assessed in all cases. No evidence of anastomotic stricture or mucous formation was found. Microscopic examination showed the substitution of bowel mucosa by squamous epithelium as well as the development of connective tissue favoring the fixation of the skeletal muscular structures of the neck to the serous layer of the graft, thus avoiding collapse of the new airway.
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PMID:Experimental reconstruction of the canine trachea with a free revascularized small bowel graft. 236 83


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